Reducing opioid use for chronic pain in older adults

2019 ◽  
Vol 76 (8) ◽  
pp. 554-559 ◽  
Author(s):  
Joshana K Goga ◽  
Annie Michaels ◽  
Marc Zisselman ◽  
Antonio DePaolo ◽  
Sunil Khushalani ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Back Pain ◽  
Health System ◽  
Chronic Back Pain ◽  
Treatment Algorithm ◽  
Private Provider ◽  
Evidence Based ◽  
Opioid Use ◽  
Alternative Medications

Abstract Purpose Implementation of the SAFE PAIN algorithm for reducing opioid use for chronic pain in older adults is described. Summary A multidisciplinary team at Sheppard Pratt Health System, the largest private provider of psychiatric care in Maryland, used lean methodology to identify the root causes for noncompliance to evidence-based practices for patients in the geropsychiatry unit treated for osteoarthritis or chronic back pain. The team collaborated to develop a facility-specific treatment algorithm, called SAFE PAIN (Sheppard Pratt Health System Algorithm For Elderly Patient Centered Analgesia Interdisciplinary Nagara), was based on the Center for Disease Control and Prevention’s evidence-based recommendations that included nonpharmacologic interventions as a first-line therapy for patients with osteoarthritis or chronic back pain. Rates of prescribing new opioids and prescribing evidence-based alternative medications via the SAFE PAIN algorithm were evaluated from March 1 to September 30, 2017 and compared with baseline (2012–2016). The lean methodology interventions led to zero new opioid orders during the study period, a significant decrease compared with previous years (p < 0.01). The rates of prescribing evidence-based alternative medications increased significantly from the baseline period to postimplementation (p < 0.01). Lean methodology interventions also decreased waste in several processes. Conclusion The prescribing rate of new opioids for osteoarthritis and chronic back pain decreased and the prescribing rate for evidence-based medications increased after implementation of the SAFE PAIN algorithm in a geropsychiatry unit.

scholarly journals Health disparities in chronic back pain and associated mortality seen in ischemic cardiac disease: a commentary

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Ashruta Patel
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Cardiac Disease ◽  
Chronic Back Pain ◽  
Chronic Neck Pain ◽  
Prescription Opioid ◽  
Chronic Lower Back Pain ◽  
Low Grade ◽  
Opioid Use ◽  
Artery Disease

AbstractPrescription opioid use for nonmalignant chronic pain has grown in the US over the last decade. Those with chronic back pain have a higher risk of mortality from ischemic heart disease than those without. Studies have demonstrated a higher prevalence of cardiac disease in adults who report chronic pain. In addition, there is research that supports some association with pain sites and cardiovascular morbidity. Studies have also shown a high-grade chronic neck pain to be more associated with cardiovascular conditions when compared to moderate or low-grade chronic pain. Given this information, it is important to assess pain medication burden present in those who have a diagnosis of coronary artery disease and chronic lower back pain.

scholarly journals Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ryu Komatsu ◽  
Michael G. Nash ◽  
Kenneth C. Ruth ◽  
William Harbour ◽  
Taylor M. Ziga ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Postoperative Pain ◽  
Pain Score ◽  
Cesarean Delivery ◽  
Chronic Back Pain ◽  
Weighted Average ◽  
Opioid Use ◽  
Opioid Dose ◽  
Chronic Pain Conditions

Introduction. Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain. However, each specific chronic pain condition has unique pathophysiology, and it is possible that the effect of each condition on postoperative pain is different. Methods. This is a retrospective cohort study of pregnant women with preexisting chronic pain conditions (i.e., migraine, chronic back pain, and the combination of migraine + chronic back pain), who underwent cesarean delivery. The effects of the three chronic pain conditions on time-weighted average (TWA) pain score (primary outcome) and opioid dose requirements in morphine milligram equivalents (MME) during postoperative 48 hours were compared. Results. The TWA pain score was similar in preexisting migraine and chronic back pain. Chronic back pain was associated with significantly greater opioid dose requirements than migraine (12.92 MME, 95% CI: 0.41 to 25.43, P = 0.041 ). Preoperative opioid use ( P < 0.001 ) was associated with a greater TWA pain score. Preoperative opioid use ( P < 0.001 ), smoking ( P = 0.004 ), and lower postoperative ibuprofen dose ( P = 0.002 ) were associated with greater opioid dose requirements. Conclusions. Findings suggest women with chronic back pain and migraine do not report different postpartum pain intensities; however, women with preexisting chronic back pain required 13 MME greater opioid dose than those with migraine during 48 hours after cesarean delivery.

scholarly journals Low Back Pain and Substance Use: Diagnostic and Administrative Coding for Opioid Use and Dependence Increased in U.S. Older Adults with Low Back Pain

Pain Medicine ◽  
2021 ◽  
Author(s):  
Beth B Hogans ◽  
Bernadette C Siaton ◽  
Michelle N Taylor ◽  
Leslie I Katzel ◽  
John D Sorkin
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
Low Back Pain ◽  
Back Pain ◽  
National Sample ◽  
Cross Sectional Study ◽  
Diagnostic Code ◽  
Low Back ◽  
Opioid Use ◽  
Cross Sectional

Abstract Objective Low back pain (LBP) is a leading cause of pain and disability. Substance use complicates the management of LBP, and potential risks increase with aging. Despite implications for an aging, diverse U.S. population, substance use and LBP comorbidity remain poorly defined. The objective of this study was to characterize LBP and substance use diagnoses in older U.S. adults by age, gender, and race. Design Cross-sectional study of a random national sample. Subjects Older adults including 1,477,594 U.S. Medicare Part B beneficiaries. Methods Bayesian analysis of 37,634,210 claims, with 10,775,869 administrative and 92,903,649 diagnostic code assignments. Results LBP was diagnosed in 14.8±0.06% of those more than 65 years of age, more in females than in males (15.8±0.08% vs. 13.4±0.09%), and slightly less in those more than 85 years of age (13.3±0.2%). Substance use diagnosis varied by substance: nicotine, 9.6±0.02%; opioid, 2.8±0.01%; and alcohol, 1.3±0.01%. Substance use diagnosis declined with advancing age cohort. Opioid use diagnosis was markedly higher for those in whom LBP was diagnosed (10.5%) than for those not diagnosed with LBP (1.5%). Most older adults (54.9%) with an opioid diagnosis were diagnosed with LBP. Gender differences were modest. Relative rates of substance use diagnoses in LBP were modest for nicotine and alcohol. Conclusions Older adults with LBP have high relative rates of opioid diagnoses, irrespective of gender or age. Most older adults with opioid-related diagnoses have LBP, compared with a minority of those not opioid diagnosed. In caring for older adults with LBP or opioid-related diagnoses, health systems must anticipate complexity and support clinicians, patients, and caregivers in managing pain comorbidities. Older adults may benefit from proactive incorporation of non-opioid pain treatments. Further study is needed.

The periaqueductal gray and descending pain modulation: why should we study them and what role do they play in chronic pain?

2015 ◽  
Vol 114 (4) ◽  
pp. 2080-2083 ◽  
Author(s):  
Kasey S. Hemington ◽  
Marie-Andrée Coulombe
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Functional Connectivity ◽  
Recent Literature ◽  
Chronic Back Pain ◽  
Periaqueductal Gray ◽  
Pain Modulation ◽  
Pain Research ◽  
Descending Pain Modulation ◽  
Pain Patients

In this Neuro Forum we discuss the significance of a recent study by Yu et al. ( Neuroimage Clin 6: 100–108, 2014). The authors examined functional connectivity of a key node of the descending pain modulation pathway, the periaqueductal gray (PAG), in chronic back pain patients. Altered PAG connectivity to pain-related regions was found; we place results within the context of recent literature and emphasize the importance of understanding the descending component of pain in pain research.

scholarly journals Prescription opioid use among older adults with arthritis or low back pain

2006 ◽  
Vol 55 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Daniel H. Solomon ◽  
Jerry Avorn ◽  
Philip S. Wang ◽  
George Vaillant ◽  
Danielle Cabral ◽  
...  
Keyword(s):  
Older Adults ◽  
Low Back Pain ◽  
Back Pain ◽  
Prescription Opioid ◽  
Low Back ◽  
Opioid Use ◽  
Prescription Opioid Use

scholarly journals Reducing Opioid Use for Patients With Chronic Pain: An Evidence-Based Perspective

2018 ◽  
Vol 98 (5) ◽  
pp. 424-433 ◽  
Author(s):  
Sarah Wenger ◽  
Jason Drott ◽  
Rebecca Fillipo ◽  
Alyssa Findlay ◽  
Amanda Genung ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Evidence Based ◽  
Opioid Use

scholarly journals Management Options for Patients with Chronic Back Pain without an Etiology

2013 ◽  
Vol 6 ◽  
pp. HSI.S10469 ◽  
Author(s):  
Lenny D. Salzberg ◽  
Eron G. Manusov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Back Pain ◽  
Lifetime Prevalence ◽  
Herniated Disc ◽  
Evidence Based ◽  
Low Back ◽  
Management Options ◽  
Evidence Based Guidelines

The treatment and management of low back pain is complex when there is no specific etiology such as cancer, fracture, or herniated disc. An organized approach to management that follows evidence based guidelines will facilitate care in a problem that reflects a lifetime prevalence of over 70 percent. The purpose of this review is to present a guideline to care for a common disabling process with a very heterogeneous etiology.

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